Division of Transplantation, Department of Surgery, University of Miami School of Medicine, Highland Professional Building, Miami, FL, USA.
Transplantation. 2010 Dec 27;90(12):1556-61. doi: 10.1097/TP.0b013e3182003db7.
This is a follow-up of a withdrawal study that we previously performed on 104 liver transplant patients in which immunosuppression was gradually withdrawn over a period of 3 years. Eighty-one patients were not able to be withdrawn (rejectors), and 23 patients were successfully weaned off immunosuppression (tolerants).
In this study, we present their follow-up after the end of the withdrawal study: we compared the results of the tolerant patients (n=23) with those of the rejectors (n=81). Follow-up was until February 2010.
Operational tolerant patients were off immunosuppression for an average of 7.27±0.28 years. Patient survival in the tolerant and the rejector groups was 63.66% and 74.25%, respectively (P=not significant). A patient in the rejector group received two retransplants for chronic rejection. In the rejector group, 19 patients presented 26 rejection episodes: clinically suspected (n=19) and biopsy-proven mild (n=4), moderate (n=2), and severe (n=1) rejection episodes. A tolerant patient had a moderate rejection episode of 5.3 years after immunosuppression withdrawal. In the rejector group, five patients received a kidney transplant and four more are on dialysis versus a tolerant patient on dialysis. Freedom from rejection in the tolerant and rejector groups was 95% and 73%, respectively (P<0.05), and freedom from renal replacement treatment was 83.33% vs. 44.58%, respectively (P=not significant).
Long-term outcomes of operationally tolerant liver transplant patients are at least as good as those of control patients. Operational tolerance is not a permanent state, and continuous vigilance is required to detect rejection episodes.
这是我们之前对 104 例肝移植患者进行的一项撤药研究的后续研究，在该研究中，我们在 3 年内逐渐撤去免疫抑制剂。81 例患者无法撤药（排斥者），23 例患者成功撤去免疫抑制剂（耐受者）。
在本研究中，我们介绍了撤药研究结束后的随访结果：我们将耐受患者（n=23）与排斥者（n=81）的结果进行了比较。随访至 2010 年 2 月。
有操作意义的耐受患者平均停用免疫抑制剂 7.27±0.28 年。耐受组和排斥组患者的生存率分别为 63.66%和 74.25%（P=无显著差异）。1 例排斥组患者因慢性排斥反应接受了 2 次肝移植。在排斥组中，19 例患者出现了 26 次排斥反应：临床疑似（n=19）和活检证实轻度（n=4）、中度（n=2）和重度（n=1）排斥反应。1 例撤药后 5.3 年出现中度排斥反应的耐受患者。在排斥组中，5 例患者接受了肾移植，4 例患者正在接受透析治疗，而耐受患者仅 1 例在接受透析治疗。耐受组和排斥组的无排斥反应率分别为 95%和 73%（P<0.05），无肾替代治疗率分别为 83.33%和 44.58%（P=无显著差异）。
有操作意义的肝移植耐受患者的长期结果至少与对照患者一样好。操作意义上的耐受不是一种永久性状态，需要持续警惕以检测排斥反应。
